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Chowdary AR, Wukich DK, Sambandam S. Complications of periprosthetic fracture revision vs aseptic revision of total knee arthroplasty. J Orthop 2024; 53:20-26. [PMID: 38450064 PMCID: PMC10912218 DOI: 10.1016/j.jor.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Background Periprosthetic fractures after total knee arthroplasty (TKA) are a challenging problem due to complex fracture patterns, poor bone quality, and a high-risk patient population. Treatment of both periprosthetic fractures and aseptic complications can include revision TKA. In this study, we compared systemic and orthopaedic complications following periprosthetic fracture associated revision TKA to aseptic revision TKA. Methods This is a retrospective cohort study using data from the years 2010-2020 from a national administrative claims database. Billing codes were used to identify revision TKAs with a diagnosis of periprosthetic fracture or aseptic complications (loosening, dislocation, arthrofibrosis, osteolysis, or prosthetic wear) within one year prior to revision. Pertinent systemic complications and rates of repeat revision TKA, periprosthetic infection, and repeat fractures were compared between the two groups. Results We identified 9891 periprosthetic fracture associated revision TKAs and 47,071 aseptic revision TKAs. Our study found higher rate of systemic complications including AKI, DVT, wound disruption, hematoma, and surgical site infections in periprosthetic fracture associated revision TKA compared to aseptic revision TKA. Furthermore, we found higher rates of repeat revision TKA, periprosthetic infections, and repeat periprosthetic fractures in fracture associated revision TKA group compared to aseptic revision group. Conclusions Our work highlights the significant short- and long-term complications associated with periprosthetic fracture associated revision TKA. Future working comparing functional outcomes and optimal surgical techniques are needed.
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Affiliation(s)
| | - Dane K. Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopaedic Surgery, Dallas VA Medical Center, Dallas, TX, USA
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2
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Harris AB, Lantieri MA, Agarwal AR, Golladay GJ, Thakkar SC. Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related Complications. J Arthroplasty 2024; 39:948-953.e1. [PMID: 37914037 DOI: 10.1016/j.arth.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The risk of revision surgery in patients who have osteoporosis after total knee arthroplasty (TKA) is understudied. Our aim was to compare the 5-year cumulative risk of revision surgery after TKA in patients who have preoperative osteoporosis. METHODS A national administrative claims database was queried for patients undergoing primary TKA from 2010 to 2021. There were 418,054 patients included, and 41,760 (10%) had osteoporosis. The 5-year incidence of revision surgery was examined for all-causes, periprosthetic fracture (PPF), aseptic loosening, and periprosthetic joint infection (PJI). A multivariable analysis was conducted using Cox proportional hazards models. Hazards ratios (HRs) were reported with 95% confidence intervals (CIs). RESULTS The 5-year rate of all-cause revision surgery was higher for patients who had osteoporosis (HR 1.1, 95% CI: 1.0 to 1.2), however, the highest risk of revision surgery was seen for PPF (HR 1.8, 95% CI: 1.6 to 2.1). Patients who had osteoporosis also had elevated risk of revision surgery for PJI (HR 1.2, 95% CI: 1.1 to 1.3) and aseptic loosening (HR 1.2, 95% CI: 1.1 to 1.3). Osteoporosis was independently associated with PJI and aseptic loosening at a higher rate in obese patients. CONCLUSIONS In unadjusted survival analysis, those who had osteoporosis have a marginally lower risk of all-cause revision surgery. However, after controlling for age, sex and comorbidities, patients who had osteoporosis have a nearly 2-fold increased risk of 5-year revision for PPF after TKA, and mildly increased risk of revision for all causes, aseptic loosening, and PJI. Obesity may also modulate this association. Future studies should determine the extent to which treatment of osteoporosis modifies these postoperative outcomes.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Mark A Lantieri
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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3
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Dragosloveanu S, Petre MA, Cretu B, Mihailescu AA, Cergan R, Scheau C. Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective. Cureus 2024; 16:e55263. [PMID: 38425332 PMCID: PMC10904024 DOI: 10.7759/cureus.55263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.
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Affiliation(s)
- Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Mihnea-Alexandru Petre
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Bogdan Cretu
- Department of Orthopaedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Alexandra Ana Mihailescu
- Department of Anesthesiology and Critical Care, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Romica Cergan
- Department of Anatomy, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
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4
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Bengoa F, Neufeld ME, Howard LC, Masri BA. Periprosthetic Fractures After a Total Knee Arthroplasty. J Am Acad Orthop Surg 2023; 31:e746-e759. [PMID: 37364252 DOI: 10.5435/jaaos-d-22-00701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
As the number of total knee arthroplasties performed continues to increase, complications such as postoperative periprosthetic fractures are becoming increasingly more common. Femoral periprosthetic fractures are the most common type of fractures around a total knee arthroplasty, whereas tibial and patellar periprosthetic fractures are infrequent. Treatment principles depend on the bone the fracture is located, the status of the implant fixation, bone stock, and the type of implants available. The Vancouver classification allows for a standardized system to describe and manage these injuries, incorporating these factors. A systematic approach is vital in obtaining the best possible outcomes because complications and mortality rates mimic those of hip fractures.
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Affiliation(s)
- Francisco Bengoa
- From the Department of Orthopaedics, the University of British Columbia, Vancouver, Canada
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Desai KB, Karumuri K, Reddy MV, Hippalgaonkar K, V R, Reddy AVG. Intraoperative Periprosthetic Fractures during primary Total knee arthroplasty: Experience from an Asian high-volume arthroplasty centre. Knee 2023; 41:342-352. [PMID: 36842266 DOI: 10.1016/j.knee.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Intraoperative periprosthetic fracture (IF) is an under-reported complication in primary total knee arthroplasty (TKA). This study aimed to audit the outcomes and complication rates in patients encountering IF during primary TKA and propose a new classification for its management. METHODS A nested case-control study was performed at a tertiary referral hospital where 50 patients encountering IF during primary TKA operated by a single surgeon team between January 2016 to May 2021, were compared with 150 (3:1) age-, gender- and implant-matched patients not encountering IF. Demographic data, risk factors, outcomes and complications of both groups were compared at a minimum follow up of 1 year. RESULTS The incidence of IF was 0.45%, with 44 fractures in the femur (88%), six (12%) in the tibia and none in the patella. Medial collateral ligament avulsion fracture (54.54%) in the femur and medial plateau fracture (66.66%) in the tibia were the most common fracture types. At final follow up, the fracture group had higher rates of 90-day re-admissions (8% vs. 2.66%, P = 0.095), deep infection (4% vs. 0.66%, P = 0.15) and revisions (6% vs. 1.33%, P = 0.06). The mean Knee Society Score was not significantly different between the two groups (152.22 ± 9.25 vs. 161.68 ± 11.22, P = 0.642) with union being achieved in all but one patient at a mean duration of 9.6 weeks. CONCLUSIONS Patients with severe and fixed deformities have a higher risk for IF. The occurrence of fracture and the complexity of surgery equally contribute to the higher complication rates. Appropriately managed fractures have comparable functional outcomes.
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Affiliation(s)
- Keyur B Desai
- Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
| | - Kishore Karumuri
- Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
| | | | | | - Ratnakar V
- Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India
| | - A V Gurava Reddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
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Christensen TH, Roof MA, Shichman I, Lygrisse KA, Aggarwal VK, Hepinstall M, Schwarzkopf R. Impact of revision TKA indications on resource utilization. Knee 2023; 41:311-321. [PMID: 36812749 DOI: 10.1016/j.knee.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/19/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Indications for surgery may impact resource utilization in aseptic revision total knee arthroplasty (rTKA), and understanding these relationships would facilitate risk-stratification preoperatively. The purpose of this study was to investigate the impact of rTKA indications on readmission, reoperation, length of stay (LOS), and cost. METHODS We reviewed all 962 patients who underwent aseptic rTKA at an academic orthopedic specialty hospital between June 2011-April 2020 with at least 90 days of follow-up. Patients were categorized based on their indication for aseptic rTKA as listed in the operative report. Demographics, surgical factors, LOS, readmission, reoperation and cost were compared between cohorts. RESULTS There were significant differences in operative time among cohorts (p < 0.001), highest among the periprosthetic fracture group (164.2 ± 59.8 min). Reoperation rate was greatest in the extensor mechanism disruption cohort (50.0 %, p = 0.009). Total cost differed significantly among groups (p < 0.001), which was highest among the implant failure cohort (134.6 % of mean) and lowest for component malpositioning cohort (90.2 % of mean). Similarly, there were significant differences in direct cost (p < 0.001) which was highest in the periprosthetic fracture cohort (138.5 % of mean), and lowest in the implant failure cohort (90.5 % of mean). There were no differences in discharge disposition, or number of re-revisions among all groups. CONCLUSIONS Operative time, components revised, LOS, readmissions, reoperation rate, total cost and direct cost following aseptic rTKA varied significantly between different revision indications. These differences should be noted for preoperative planning, resource allocation, scheduling, and risk-stratification. LEVEL OF EVIDENCE III, retrospective observational analysis.
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Affiliation(s)
- Thomas H Christensen
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States
| | - Mackenzie A Roof
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States
| | - Ittai Shichman
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States
| | - Matthew Hepinstall
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, United States.
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7
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Tarity TD, Xiang W, Guirguis P, Gausden EB, Chalmers BP, Boettner F, Carli AV, Sculco PK. Early Femoral Insufficiency Fractures After Primary Total Knee Arthroplasty. Arthroplast Today 2023; 20:101110. [PMID: 36844655 PMCID: PMC9950380 DOI: 10.1016/j.artd.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/20/2022] [Accepted: 01/22/2023] [Indexed: 02/28/2023] Open
Abstract
Background Periprosthetic femur fracture following total knee arthroplasty (TKA) is a devastating complication. Although trauma-related periprosthetic femur fractures have been well studied, early atraumatic insufficiency periprosthetic fractures (IPFs) are gaining attention. We present the largest IPF series to date to better understand and prevent this complication. Methods A retrospective study of all patients who underwent a revision surgery for periprosthetic fracture within 6 months of primary TKA between 2007 and 2020 was performed. Patient demographics, preoperative radiographs, implant details, and fracture radiographs were reviewed. Alignment measurements and fracture characteristics were assessed. Results Sixteen patients met criteria (rate 0.05%), and 11 had posterior-stabilized TKAs. The mean age was 79 years, mean body mass index was 31 kg/m2, and 94% (15/16) were female. Seven (47%) patients had a confirmed history of osteoporosis. IPF occurred on average 4 weeks (range, 4 days-13 weeks) after the index TKA. Overall, 12 of 16 (73%) had preoperative valgus deformities, and 11 patients (10 valgus, 1 varus) had preoperative deformities >10 degrees. A characteristic radiographic appearance of femoral condylar impaction and collapse was noted in 12 of 16 cases (75%); 11 of these 12 fractures (92%) involved the unloaded compartment based on preoperative varus/valgus deformity. Conclusions Patients who developed IPFs were most commonly elderly, obese women with osteoporosis and severe preoperative valgus deformities. The apparent mechanism of failure was overloading of previously unloaded osteopenic femoral condyle. In high-risk patients, the use of a cruciate-retaining femoral component or a femoral stem for a posterior-stabilized femur may be considered to help avoid this catastrophic complication.
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Affiliation(s)
- T. David Tarity
- Corresponding author. Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA. Tel.: +1 212 606 1000.
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8
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Pellegrino A, Coscione A, Santulli A, Pellegrino G, Paracuollo M. KNEE PERIPROSTHETIC FRACTURES IN THE ELDERLY: CURRENT CONCEPT. Orthop Rev (Pavia) 2022; 14:38566. [DOI: 10.52965/001c.38566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Periprosthetic fractures around total knee arthroplasty in elderly represent an emerging cause of implant revision and their incidence seems destined to further increase in the upcoming years, considering the ever-increasing number of implanted prostheses. These are complex injuries with very high complication rates. It has been estimated that the incidence of femoral periprosthetic fractures after T.K.A. ranged between 0,3 to 2,5%, but increases up to 38% when considering revision T.K.A. Patient-related risk factors for T.K.A. periprosthetic fracture (T.K.A.P.F.) include osteoporosis, age, female sex, revision arthroplasty and peri-implant osteolysis. The grate debate concerns the choice of the most appropriate fixation device for T.K.A.P.F.: closed or open reduction with internal fixation with either locked plate or intramedullary nail is the most commonly used for treating these fractures. Success of these methods depends on the fracture pattern, the stability of implants, and the patient’s bone quality which is often poor in elderly, thus resulting in high complication rates. Conversely, a revision of T.K.A. (R.T.K.A.) should be considered in case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture (that precludes a good fixation), previous treatments failure and severe malalignment of T.K.A. Instead megaprosthesis and allograft-prosthesis composite are necessary in case of sever bone loss. Considering the variability of the clinical scenario of T.K.A.P.F., this complex injury requires and experienced and comprehensive approach based on both facture fixation and/or revision arthroplasty.
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Affiliation(s)
- Achille Pellegrino
- Department of Orthopedics and Traumatology , “S. G. Moscati” Hospital - Aversa (CE) – Italy
| | - Andrea Coscione
- Department of Orthopedics and Traumatology , “S. G. Moscati” Hospital - Aversa (CE) – Italy
| | - Adriano Santulli
- Department of Orthopedics and Traumatology , “S. G. Moscati” Hospital - Aversa (CE) – Italy
| | - Giuseppe Pellegrino
- Department of Orthopedics and Traumatology , “S. G. Moscati” Hospital - Aversa (CE) – Italy
| | - Mario Paracuollo
- Department of Orthopedics and Traumatology , “S. G. Moscati” Hospital - Aversa (CE) – Italy
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9
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McMellen CJ, Romeo NM. Interprosthetic Femur Fractures: A Review Article. JBJS Rev 2022; 10:01874474-202209000-00004. [PMID: 36137069 DOI: 10.2106/jbjs.rvw.22.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ The prevalence of interprosthetic femur fractures (IFFs) is rising with the aging population and increased prevalence of total joint arthroplasty. ➢ IFFs have high rates of complications and high associated morbidity and mortality. ➢ The main treatment methods available for IFFs include plate fixation, intramedullary nailing, combined plate fixation and intramedullary nailing, and revision arthroplasty including partial and total femur replacement. ➢ There have been several proposed classification systems and at least 1 proposed treatment algorithm for IFFs; however, there is no consensus. ➢ Whichever treatment option is chosen, goals of surgery should include preservation of blood supply, restoration of length, alignment, rotation, and sufficient stabilization to allow for early mobilization.
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Affiliation(s)
- Christopher J McMellen
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Nicholas M Romeo
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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10
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Distal femoral replacement or internal fixation for management of periprosthetic distal femur fractures: A systematic review. Knee 2022; 37:121-131. [PMID: 35772245 DOI: 10.1016/j.knee.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The number of periprosthetic fractures above a total knee arthroplasty continues to increase. These fractures are associated with a high risk of morbidity and mortality. Techniques for addressing these fractures include open reduction internal fixation (ORIF) and revision arthroplasty, including distal femoral replacement (DFR). The primary aim of this review is to compare mortality and reoperation rates between ORIF and DFR when used to treat periprosthetic distal femur fractures. METHODS A systematic review including MEDLINE, Embase and Cochrane Library databases was completed from inception to April 10, 2021. Studies including a comparator cohort were meta-analyzed. RESULTS Fourteen studies were identified for inclusion, of which, five had sufficient homogeneity for inclusion in a meta-analysis. 30-day and 2-year mortality was 4.1% and 14.6% in the DFR group. There was no statistically significant difference between ORIF and DFR (log Odds-Ratio (OR) = -0.14, 95 %CI: -0.77 to 0.50). The reoperation rate in the DFR group was 9.3% versus 14.8% for ORIF, with no difference between groups (log OR = 0.10, 95 %CI: -0.59 to 0.79). There was no difference in rates of deep infection (log OR = 0.22, 95 %CI: -0.83 to 1.28). Direct comparison of functional outcomes was not possible, though did not appear significant. CONCLUSION DFR in the setting of periprosthetic distal femur fractures is equivalent to ORIF with respect to mortality and reoperation rate and thus a safe and reliable treatment strategy. DFR may be more reliable in complex fracture patterns where the ability to obtain adequate fixation is difficult.
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11
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LEWIS PL, W-DAHL A, ROBERTSSON O, PRENTICE HA, GRAVES SE. Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA. Acta Orthop 2022; 93:623-633. [PMID: 35819795 PMCID: PMC9275496 DOI: 10.2340/17453674.2022.3512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. PATIENTS AND METHODS We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. RESULTS We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4-2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1-2.5), for fracture were female sex (OR 3.2; CI 2.2-4.8), age ≥ 65 years (OR 2.8; CI 1.9-4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3-3.5), for infection were male sex (OR 1.9; CI 1.7-2.0) and PS (OR 1.5; CI 1.2-1.8), for instability were age < 65 years (OR 1.5; CI 1.3-1.8) and MB (OR 1.5; CI 1.1-2.2), for loosening were PS (OR 1.5; CI 1.4-1.6), MB (OR 2.2; CI 1.6-3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8-2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1-87.2) and MB (OR 2.0; CI 1.2-3.3) and for wear was cementless fixation (OR 4.9; CI 4.3-5.5). INTERPRETATION Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.
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Affiliation(s)
- Peter L LEWIS
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Annette W-DAHL
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Otto ROBERTSSON
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Stephen E GRAVES
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia
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12
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Aebischer AS, Hau R, de Steiger RN, Holder C, Wall CJ. Distal Femoral Replacement for Periprosthetic Fractures After TKA: Australian Orthopaedic Association National Joint Replacement Registry Review. J Arthroplasty 2022; 37:1354-1358. [PMID: 35271977 DOI: 10.1016/j.arth.2022.02.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Distal femoral replacement (DFR) is a potential treatment option following periprosthetic fracture (PPF) of a total knee arthroplasty (TKA). However, there is limited literature regarding implant survivorship and complication rates. The aim of this study was to examine patient demographics and trends in usage, implant survivorship and modes of failure, and patient mortality following DFR for PPF captured by a national joint replacement registry. METHODS A retrospective registry review was performed using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). In total, 306 DFR were performed for PPF of a known primary TKA. Eighty-five percent of patients were female, and the mean age was 76.4 years. Kaplan-Meier estimates of implant and patient survivorship were performed. RESULTS The number of DFR performed for PPF has doubled over the past five years. The cumulative percent second revision rate at six years was 12%. The most common indications for revision were infection (37%) and aseptic loosening (33%). Patient survivorship after DFR was 97% and 83% at five and ten years, respectively. CONCLUSION A national registry review has identified the increasing prevalence of DFR for PPF after primary TKA and demonstrated implant survivorship of 88% at midterm follow-up. Surgeons may consider DFR as an acceptable and durable treatment option. LEVEL OF EVIDENCE Level III - Case Series.
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Affiliation(s)
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; Department of Surgery, University of Melbourne, Northern Medical School, Epping, Victoria, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Carl Holder
- MBiostat, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Australia; School of Medicine Rural Clinical School, University of Queensland, Toowoomba, Australia
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13
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Shukla T, Vaish A, Vaishya R, Patralekh MK. Tibial periprosthetic fractures in Total Knee Arthroplasty - A scoping review. J Clin Orthop Trauma 2022; 29:101892. [PMID: 35601511 PMCID: PMC9118506 DOI: 10.1016/j.jcot.2022.101892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Periprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations. Methods A literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review. Results We included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1). Conclusion Intraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture. Level of evidence IV.
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Affiliation(s)
- Tapish Shukla
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India
| | - Mohit Kumar Patralekh
- Chief Medical Officer & Orthopaedic Surgeon, Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India
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14
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Vitiello R, Ziranu A, Oliva MS, Meluzio MC, Cauteruccio M, Maccauro G, Liuzza F, Saccomanno MF. The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results. Injury 2022; 53:1241-1246. [PMID: 34602244 DOI: 10.1016/j.injury.2021.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of both hip and distal femur fractures as well as periprosthetic fractures can be challenging for orthopaedic surgeons. The use of megaprosthetic implants could provide substantial advantages in elderly population affected by complex fractures. The aim of the study was to evaluate the effectiveness of megaprosthetic implants for treating hip and distal femur fractures as well as periprosthetic fractures in elderly. MATERIAL AND METHODS From January 1st 2015 to December 31st 2019, patients treated for proximal or distal femoral fractures with severe bone loss or failure of previous surgery were retrospectively reviewed. Patients were divided into two group based on diagnosis: proximal femur fractures (group A) and distal femur fractures (group B). Subsequently, patients underwent hip (group A) or knee (group B) megaprosthesis. Self-assessed questionnaires were administered to all patients pre and postoperatively. Primary outcome was the Activity Daily Living. Secondary outcomes were: Instrumental Activity Daily Living, Short Form-12, Oxford knee or hip score, complications. Charlson score, Harris classification for hip or Anderson Orthopaedic Research Institute score and complication were recorded. All patients underwent a radiological follow up to rule out implant loosening and mobilization. Pre and postoperative functional score comparisons in each group were undertaken. Significance was set p ≤ 0.05. RESULTS Twelve patients were finally included in the study. There were 6 male and 6 females, the mean age was 72,9 years old (± 7,4); the mean BMI was 29,8 points (± 4.5). The mean follow-up was 2.9 years (± 1.4). No differences could be found between pre and postoperative evaluation in each group. No aseptic loosening, dislocation, mobilization or radiolucency were recorded during the follow-up. In group A, two surgical site infections (2/6 patients) and one pneumonia (1/6 patients) were recorded. In group B, two surgical site infections occurred (2/6 patients). All patients were treated by antimicrobial oral therapy with complete regression. CONCLUSION The use of hip and knee megaprosthetic implants in traumatology is a safe and viable option in elderly patients.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Antonio Ziranu
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Maria Serena Oliva
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia.
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Michele Cauteruccio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Giulio Maccauro
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
| | - Francesco Liuzza
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italia; Università Cattolica Del Sacro Cuore, Roma, Italia
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15
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Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation. J Clin Med 2021; 10:jcm10214926. [PMID: 34768444 PMCID: PMC8584452 DOI: 10.3390/jcm10214926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.
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16
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Mohler SA, Stambough JB, Mears SC, Barnes CL, Stronach BM. A Review of Periprosthetic Tibial Fractures: Diagnosis and Treatment. Orthop Clin North Am 2021; 52:357-368. [PMID: 34538348 DOI: 10.1016/j.ocl.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periprosthetic fracture occurring during or after total knee arthroplasty is a rare injury. Literature concerning periprosthetic tibial factures is sparse, and there is limited guidance for evidence-based management. This review aims to provide readers with an overview of the epidemiology, risk factors, and classification of these fractures. Management includes nonoperative treatment of nondisplaced fractures, fixation for those with stable implants, and revision for those with loose implants.
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Affiliation(s)
- Samantha A Mohler
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Jeffery B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Charles Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot # 531, Little Rock, AR 72205, USA.
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17
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Chalmers BP, Syku M, Gausden EB, Blevins JL, Mayman DJ, Sculco PK. Contemporary Distal Femoral Replacements for Supracondylar Femoral Fractures Around Primary and Revision Total Knee Arthroplasties. J Arthroplasty 2021; 36:S351-S357. [PMID: 33487512 DOI: 10.1016/j.arth.2020.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is a paucity of data on the outcomes of distal femoral replacements (DFRs) in patients with total knee arthroplasty (TKA) periprosthetic fractures. We sought to characterize these patients' survivorship free from rerevision. METHODS We retrospectively identified 49 patients, including 34 after primary TKA (primary cohort), 9 after revision TKA, and 6 conversions for failed open reduction and internal fixation (revision cohort) that underwent DFR for a periprosthetic femur fracture. The mean age was 76 years, and 40 patients (82%) were female. The mean follow-up was 4 years. Femoral fixation included 44 cemented stems (90%) and 5 cementless stems (10%). Survivorship free from rerevision was characterized by the Kaplan-Meier method; cox proportional regression was used to analyze the risk factors for rerevision. RESULTS Survivorship free from any rerevision at 5 years in the primary and revision cohort was 93% and 18%, respectively. The revision cohort had a 5.3× higher risk of re-revision (P = .008). Survivorship free from re-revision for aseptic loosening at 5 years in the primary and revision cohort was 93% and 53%, respectively. Two of the 3 patients with cementless stems in the primary cohort underwent early rerevision for aseptic loosening, but patients with prior primary TKAs treated with cemented femoral fixation (n = 31) had a 97% 5-year survivorship free from re-revision. CONCLUSION Patients with periprosthetic fractures around prior primary TKAs treated with DFRs with cemented femoral fixation had a 97% 5-year survivorship free from any re-revision. DFRs for periprosthetic femur fractures around revision TKAs or conversions of failed open reduction and internal fixations have a 5× increased risk of rerevision.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Marie Syku
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Jason L Blevins
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
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18
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Pfeufer D, Gililland J, Monteiro P, Stagg M, Anderson MB, Peters CL, Pelt CE. Outcomes of Rotating-hinge Total Knee Arthroplasty Following Complex Primary and Revision Total Knee Arthroplasty. Surg Technol Int 2021; 38:446-450. [PMID: 33830492 DOI: 10.52198/21.sti.38.os1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In complex primary and revision total knee arthroplasty (TKA), rotating-hinge TKA (RH-TKA) prostheses play an important role. Compared to early fixed-hinge knee designs, new implants that include rotating platforms and improved hinge constructs may offer improvements in both survival and clinical outcomes. We sought to evaluate early survival following complex primary and revision TKA with a rotating-hinge knee prosthesis. We retrospectively reviewed a consecutive series of patients (n=47, 48 knees) who underwent revision TKA using an RH-TKA system. The mean age was 73 years (range, 37 - 86). The mean body mass index was 29 (range, 16.3 - 45.9) and the median ASA score was 3 (IQR, 2 - 3). As mortality was high, we performed a Kaplan-Meier analysis to evaluate survival, with death as failure. The median follow-up was 2.5 years (range, 0.07 - 9.8). Revision-free survival was 97% at a median 2.5 years of follow-up. Overall mortality was 46% (17/37) and survival free from death was 69% (49% - 82%) at a median of 2.5 years. Most reoperations were due to infection (5/12), following by wound-related complications (2/12) and hematomas (2/12). A high postoperative complication rate and mortality are evident in TKA using a hinged knee prosthesis in complex revision TKA. If the indication and surgical technique are matched to the complexity of the case, this type of implant offers a feasible salvage procedure.
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Affiliation(s)
- Daniel Pfeufer
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Jeremy Gililland
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Priscila Monteiro
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Marissa Stagg
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Mike B Anderson
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
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19
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Stamiris D, Gkekas NK, Asteriadis K, Stamiris S, Anagnostis P, Poultsides L, Sarris I, Potoupnis M, Kenanidis E, Tsiridis E. Anterior femoral notching ≥ 3 mm is associated with increased risk for supracondylar periprosthetic femoral fracture after total knee arthroplasty: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:383-393. [PMID: 33900452 DOI: 10.1007/s00590-021-02989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA. METHODS A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle-Ottawa scale was implemented for quality assessment of the included studies. RESULTS Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22-12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08-11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN < 3 mm compared to the control group (OR 5.0, 95% CI 0.44-56.82, p = 0.19; I2 42.99%). CONCLUSION Patients, exposed to AFN ≥ 3 mm in depth, are at higher risk for sustaining a sPPF.
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Affiliation(s)
- Dimitrios Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece. .,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece. .,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Nifon K Gkekas
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Asteriadis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.,Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros Poultsides
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sarris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg 2021; 141:207-214. [PMID: 33128096 DOI: 10.1007/s00402-020-03655-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Very low periprosthetic distal femur fractures (PPDFFs) are rare injuries and often have a relatively high failure rate after single lateral locked plating. The double plating technique yields good outcomes in osteoporotic fractures of the distal femur. To date, there is limited information on double-locked plate fixation of very low PPDFFs. This study aimed to evaluate the outcomes and complications of surgically treated very low PPDFFs using double-locked plate fixation. MATERIALS AND METHODS Between January 2013 and December 2018, sixty-one consecutive patients with PPDFFs have been conducted. Only Su type III PPDFFs with double-locked plate fixation through a lateral minimally invasive approach and a medial subvastus approach to the distal femur were analyzed. Patients were encouraged to perform straight leg raising exercises and active knee motion on the second postoperative day. Assisted weight bearing from the early postoperative days was supported, and full weight-bearing was allowed after healing the fracture site. All patients were evaluated according to the time to union, limb alignment, range of knee motion, Knee Society Score, and presence of complications. RESULTS Twenty one patients (17 females and 4 males, mean age 76 years, range 56-90) were included in the study. There were 10 of 33-A1, 6 of 33-A2 and 5 of 33 A3 fractures, according to the AO classification. Of 21 patients, 20 achieved union at an average of 14 weeks postoperatively. Postoperative limb alignment was satisfactory in all cases, with an average mechanical distal lateral femur angle of 89° and average mechanical posterior distal femur angle of 86°. All patients recovered the knee joint motion similar to that of the contralateral side, and daily life pre-injury. The average knee and function scores were 94 and 89, respectively. There were one case of non-union and three cases of superficial wound infection, which resolved after intravenous antibiotic therapy. CONCLUSIONS Double locked plating showed excellent radiographic and functional outcomes with few complications in patients with very low PPDFFs. Based on these promising results, we propose the consideration of double-locked plate fixation in the treatment of very low PPDFFs.
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21
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Pagani NR, Varady NH, Chen AF, Rajaee SS, Kavolus JJ. Nationwide Analysis of Lower Extremity Periprosthetic Fractures. J Arthroplasty 2021; 36:317-324. [PMID: 32826143 DOI: 10.1016/j.arth.2020.07.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the annual incidence of primary total joint arthroplasty is increasing, trends in the annual incidence of periprosthetic fractures have not been established. This study aimed to define the annual incidence of periprosthetic fractures in the United States. METHODS Inpatient admission data for 60,887 surgically treated lower extremity periprosthetic fractures between 2006 and 2015 were obtained from the National Inpatient Sample database. The annual incidence of periprosthetic fractures was defined as the number of new cases per year and presented as a population-adjusted rate per 100,000 US individuals. Univariable methods were used for trend analysis and comparisons between groups. RESULTS The national annual incidence of periprosthetic fractures presented as a population-adjusted rate of new cases per year peaked in 2008 (2.72; 95% confidence interval [95% CI], 2.39-3.05), remained stable from 2010 (1.65; 95% CI, 1.45-1.86) through 2013 (1.67; 95% CI, 1.55-1.8) and increased in 2014 (1.99; 95% CI, 1.85-2.13) and 2015 (2.47; 95% CI, 2.31-2.62). The proportion of femoral periprosthetic fractures managed with total knee arthroplasty revision remained stable (Ptrend = .97) with an increase in total hip arthroplasty (THA) revision (Ptrend < .001) and concurrent decrease in open reduction and internal fixation (ORIF) (Ptrend < .001). Revision THA was significantly more costly than revision total knee arthroplasty (P = .004), and both were significantly more costly than ORIF (P < .001 for both). CONCLUSION The annual incidence of periprosthetic fractures remained relatively stable throughout our study period. The proportion of periprosthetic fractures managed with revision THA increased, whereas ORIF decreased. Our findings are encouraging considering the significant burden an increase in periprosthetic fracture incidence would present to the health care system in terms of both expense and patient morbidity.
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Affiliation(s)
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joseph J Kavolus
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA
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22
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Ragland K, Cherney SM, Stambough JB, Mears SC. Open Periprosthetic Knee Fracture: A Case Report and Review of the Literature. Geriatr Orthop Surg Rehabil 2020; 11:2151459320939547. [PMID: 33178480 PMCID: PMC7592100 DOI: 10.1177/2151459320939547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/07/2020] [Accepted: 05/31/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: With the increase in knee and hip implants, these periprosthetic fractures will become more common especially as the population ages. Open periprosthetic fractures are rare and severe injuries and are more likely to be seen in high-energy injuries. They present challenges to the treating physician due to soft tissue damage, contamination of the existing implants, and the effects of polytrauma in the geriatric patient. Methods: Case review report and review of literature. Results A 72-year-old woman was involved in a motor vehicle collision with multiple injuries including an open periprosthetic tibia and femur fracture. This was treated with initial washout and removal of loose tibial component with placement of a cement spacer. The knee was treated with staged revision using a protocol like that used after prosthetic joint infection. After complete soft tissue healing, the patient underwent successful revision with a megaprosthesis. The literature on open periprosthetic fractures is reviewed. Discussion and Conclusion: Open periprosthetic fractures present multiple challenges to the orthopedic surgeon. In the presences of poly trauma and soft tissue injury, we present an approach using staged surgery like that used for prosthetic joint infection.
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Affiliation(s)
- Katelyn Ragland
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven M Cherney
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Taylor SK, Sephian A, Clader T. Intraoperative tibial plateau fracture during bone preparation in a cruciate retaining primary total knee arthroplasty. BMJ Case Rep 2020; 13:13/9/e233826. [PMID: 32963039 DOI: 10.1136/bcr-2019-233826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intraoperative fractures are a rare complication in total knee arthroplasty. Limited literature exists in regard to the incidence, mechanism of injury and management of intraoperative fractures. The authors report a unique case of an 80-year-old man who sustained a medial tibial plateau fracture that occurred intraoperatively during final tibia bone preparation with the use of the Woolley Tibia Punch (Innomed, Savannah, Georgia, USA). The fracture was managed with the addition of 4.5 mm cortical lag screws and the addition of a stemmed tibial implant to bypass the fracture. This is the first reported case in literature that describes an intraoperative medial tibial plateau that occurred through the use of a Woolley Tibia Punch. The authors recommend the consideration of drilling to prepare sclerotic bone for cement penetration rather than a punch in order to minimise the potential for intraoperative fractures that may occur with the use of a punch.
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Affiliation(s)
- Shea K Taylor
- Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Andrew Sephian
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Timothy Clader
- Orthopaedic Surgery Department, James A Haley Veterans Hospital, Tampa, Florida, USA
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24
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Yi PH, Della Valle CJ, Fishman EK, Fritz J. Imaging of Periprosthetic Fractures of the Hip and Knee. Semin Roentgenol 2020; 56:90-105. [PMID: 33422187 DOI: 10.1053/j.ro.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, NY..
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Krebs OK, Warren JA, Anis HK, George J, McLaughlin J, Molloy RM, Krebs VE, Piuzzi NS. Estimated Glomerular Filtration Rate as a Risk Stratification Tool for Early Complications in Revision Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35:1315-1322. [PMID: 31901306 DOI: 10.1016/j.arth.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Establishing an association between postoperative outcomes and the spectrum of renal function would allow for more informed decisions to manage surgical risks and improved patient-specific care. Estimated glomerular filtration rate (eGFR) can be calculated from standard prescreening measurements to gauge renal function. This work investigates the effect of eGFR, as a continuous and categorical variable, on mortality and major and minor complications in patients undergoing revision total knee and hip arthroplasty. METHODS 25,056 patients having undergone revision total hip and knee arthroplasty from 2013 to 2016 were identified using the National Quality Improvement Program database. The investigated outcomes included 30-day mortality, major complications, and minor complications. Multivariate regression models were created to evaluate the effect of eGFR on the outcomes of interest. Multivariate spline regressions were generated to assess for nonlinear relationships between eGFR as a continuous variable and the outcomes. RESULTS Our study revealed that as eGFR decreased <60 mL/min/1.73 m2, mortality (P = .0001), any major complication (P < .001), and any minor complication (P < .001) increased. Patients with eGFR 15-30 mL/min/1.73 m2 had increased risk for mortality (P = .033). There was an increased risk for any major complication at an eGFR 30-60 and <15 mL/min/1.73 m2, (P < .05). There was an increased risk of minor complications for those with hyperfiltration and <60 mL/min/1.73 m2. CONCLUSION Patients with lower preoperative eGFR generally display an increased risk for complications after revision total hip and knee arthroplasty. Proper consideration should be given to this patient population before surgical intervention to allow for preventative measures to be taken to improve patient outcomes.
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Affiliation(s)
- Olivia K Krebs
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Jared A Warren
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Hiba K Anis
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Jaiben George
- All-Indian Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - John McLaughlin
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Robert M Molloy
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH
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26
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Bauer C, Zaharia B, Galliot F, Parot J, Houfani F, Mayer J, Mainard D. Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years' follow-up. Orthop Traumatol Surg Res 2020; 106:449-458. [PMID: 32184065 DOI: 10.1016/j.otsr.2020.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess treatment efficacy, on the hypothesis that surgery provides good long-term results. MATERIAL AND METHODS A two-center retrospective study included 15 patients (6 male, 9 female: mean age, 71.8±10.2 years), managed between 1997 and 2017 for isolated tibial fracture after TKA. Patients were assessed clinically (IKS, inverted Oxford, Parker and SF-12 scores) and radiologically. Complications and revision surgeries were collated. Fractures were classified on the SoFCOT classification: 9 stable implants (4 type B1, 5 type C1), 4 periprosthetic osteolyses (1 type A3, 2 type B3, 1 type C3), and 2 loosenings (type A2). Treatments comprised: non-operative treatment (1 bed-ridden patient), 11 osteosyntheses for fracture on stable implant (2 standard plates, 7 locking plates, 2 intramedullary nailings), and 3 implant replacements by cemented long stem models for loosening. RESULTS Mean follow-up was 28 months (range, 12-120 months). Consolidation was achieved in 13 cases, at a mean 15 weeks. Complications comprised: 4 infections, 2 cases of secondary displacement, and 2 of non-union. Surgical revision was required in 8 cases, including 2 secondary implant revision procedures. Functional results were good in 10 cases. At last follow-up, mean Parker score was 7 (range, 4-8.5), Oxford score 32 (range, 16-39), and IKS score 150 (range, 85-167) with knee and function scores respectively 78 (range, 55-86) and 75 (range, 30-85). CONCLUSION Radiologic and clinical results were encouraging, but with impaired quality of life and a high rate of complications. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Camille Bauer
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - Bogdan Zaharia
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Florent Galliot
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Jauffrey Parot
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Fayçal Houfani
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Julien Mayer
- Service de chirurgie orthopédique et traumatologique, hôpital de Mercy, CHR de Metz-Thionville, 1, allée du Château, 57245 Ars-Laquenexy, France
| | - Didier Mainard
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
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Limberg AK, Tibbo ME, Pagnano MW, Perry KI, Hanssen AD, Abdel MP. Varus-valgus constraint in 416 revision total knee arthroplasties with cemented stems provides a reliable reconstruction with a low subsequent revision rate at early to mid-term review. Bone Joint J 2020; 102-B:458-462. [PMID: 32228079 DOI: 10.1302/0301-620x.102b4.bjj-2019-0719.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Varus-valgus constrained (VVC) implants are often used during revision total knee arthroplasty (TKA) to gain coronal plane stability. However, the increased mechanical torque applied to the bone-cement interface theoretically increases the risk of aseptic loosening. We assessed mid-term survivorship, complications, and clinical outcomes of a fixed-bearing VVC device in revision TKAs. METHODS A total of 416 consecutive revision TKAs (398 patients) were performed at our institution using a single fixed-bearing VVC TKA from 2007 to 2015. Mean age was 64 years (33 to 88) with 50% male (199). Index revision TKA diagnoses were: instability (n = 122, 29%), aseptic loosening (n = 105, 25%), and prosthetic joint infection (PJI) (n = 97, 23%). All devices were cemented on the epiphyseal surfaces. Femoral stems were used in 97% (n = 402) of cases, tibial stems in 95% (n = 394) of cases; all were cemented. In total, 93% (n = 389) of cases required a stemmed femoral and tibial component. Femoral cones were used in 29%, and tibial cones in 40%. Survivorship was assessed via competing risk analysis; clinical outcomes were determined using Knee Society Scores (KSSs) and range of movement (ROM). Mean follow-up was four years (2 to 10). RESULTS The five-year cumulative incidence of subsequent revision for aseptic loosening and instability were 2% (95% confidence interval (CI) 0.2 to 3, number at risk = 154) and 4% (95% CI 2 to 6, number at risk = 153), respectively. The five-year cumulative incidence of any subsequent revision was 14% (95% CI 10 to 18, number at risk = 150). Reasons for subsequent revision included PJI (n = 23, of whom 12 had previous PJI), instability (n = 13), and aseptic loosening (n = 11). The use of this implant without stems was found to be a significant risk factor for subsequent revision (hazard ratio (HR) 7.58 (95% CI 3.98 to 16.03); p = 0.007). KSS improved from 46 preoperatively to 81 at latest follow-up (p < 0.001). ROM improved from 96° prerevision to 108° at latest follow-up (p = 0.016). CONCLUSION The cumulative incidence of subsequent revision for aseptic loosening and instability was very low at five years with this fixed-bearing VVC implant in revision TKAs. Routine use of cemented and stemmed components with targeted use of metaphyseal cones likely contributed to this low rate of aseptic loosening. Cite this article: Bone Joint J 2020;102-B(4):458-462.
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Affiliation(s)
- Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Nozaka K, Miyakoshi N, Sato T, Shimada Y. Ilizarov external fixation for a periprosthetic tibial fracture in severe osteoporosis: a case report. BMC Musculoskelet Disord 2020; 21:145. [PMID: 32131797 PMCID: PMC7057544 DOI: 10.1186/s12891-020-3176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to the increasing number of TKAs performed annually and the growing elderly population. A periprosthetic fracture of the proximal tibia following TKA is a rare injury that may be a challenging clinical scenario. Case presentation The case of an 84-year-old woman who sustained a periprosthetic tibial fracture 10 years after a TKA is presented. This patient had multiple risk factors. The fracture was not deemed amenable to conventional treatment because the bone fragment was too small. This patient underwent fixation of her tibial fracture above the TKA using a five-ring Ilizarov external fixator. This allowed immediate full weight-bearing. The fixator was removed at 12 weeks, at which time the fracture was solidly healed. At the most recent follow-up, 2 years from injury, she was fully weight-bearing without walking aids and had a knee range of motion (ROM) of 0–110°. Conclusion To the best of our knowledge, this is the first report in which Ilizarov external fixation has been used for a periprosthetic tibial fracture after TKA.
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Affiliation(s)
- Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takeshi Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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29
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Rice OM, Springer BD, Karunakar MA. Acute Distal Femoral Replacement for Fractures About the Knee in the Elderly. Orthop Clin North Am 2020; 51:27-36. [PMID: 31739877 DOI: 10.1016/j.ocl.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal femoral replacement (DFR) is a reasonable treatment option when used for select indications. In the setting of comminuted intra-articular distal femoral fractures, distal femoral arthroplasty should be considered in low-demand patients with poor bone quality. This article summarizes the existing literature plus the authors' personal experience with DFR use for distal femoral fractures of the native knee.
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Affiliation(s)
- Olivia M Rice
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue Suite 200A, Charlotte, NC 28207, USA
| | - Madhav A Karunakar
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
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30
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Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:25-32. [PMID: 31821280 PMCID: PMC7233703 DOI: 10.23750/abm.v90i12-s.8958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022]
Abstract
Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy..
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31
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Benkovich V, Klassov Y, Mazilis B, Bloom S. Periprosthetic fractures of the knee: a comprehensive review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:387-399. [PMID: 31745642 PMCID: PMC7138771 DOI: 10.1007/s00590-019-02582-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
Abstract
Demographic changes have resulted in an increase in the number of older patients diagnosed with degenerative joint disease. Developments in the field of joint arthroplasty allow a broader population to improve their lifestyles. An increased demand for knee arthroplasty has led to a rise in operations performed worldwide. Although there has been a constant propagation of technology and an increase in medical staffing at a professional level, many patients still encounter complications. Though rare, these factors may lead to life-threatening scenarios and a devastating effect on the success of the operation. One such rare complication includes periprosthetic fractures around the knee, a complex injury which requires a cautious and experienced approach. In this review, we analyze the prevalence, risk factors and classification, investigation and treatment options for periprosthetic fractures with total knee arthroplasty.
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Affiliation(s)
- Vadim Benkovich
- Department of Joint Arthroplasty, “Yonatan” Center-Israeli Joint and Spine Health Center, Assuta Medical Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuri Klassov
- Orthopedic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Boris Mazilis
- Ben Gurion University, Soroka medical Center, Beer-Sheva, Israel
| | - Shlomo Bloom
- Orthopedic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel
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Morwood MP, Gebhart SS, Zamith N, Mir HR. Outcomes of fixation for periprosthetic tibia fractures around and below total knee arthroplasty. Injury 2019; 50:978-982. [PMID: 30929804 DOI: 10.1016/j.injury.2019.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to an increasing number of TKAs performed annually and the growing elderly population. Like periprosthetic fractures of the distal femur, periprosthetic tibia fractures are primarily treated with operative fixation; however, there is limited scientific literature that has reported outcomes of periprosthetic tibia fractures treated with modern plating techniques. To our knowledge, this is the largest series of non-intraoperative periprosthetic tibia fractures treated with open reduction internal fixation (ORIF) ever reported. METHODS Retrospective chart review of 4557 operatively treated tibia fractures with ORIF over a 16-year period at two Level 1 Trauma Centers. RESULTS 38 patients with an average follow-up of 15.3 months (range 3-24) were identified. 11 (28.9%) fractures were in the proximal tibia (four with extension into the plateau (Felix 1A) and seven adjacent to the tibial stem (Felix 2A)), six (15.8%) in the midshaft/diaphysis (Felix 3A), and 21 (55.3%) in the distal 1/3rd (metaphysis, Felix 3A). 76.3% (29/38) of fractures united by 6 months following the index procedure, leaving 9 nonunions. The overall re-operation rate was 31.6% (12/38). There were no significant differences in rates of union (p = 1.00), reoperation (p = 0.66), superficial infection (p = 0.66), or deep infection (p = 0.31) in patients treated with single versus dual plating. CONCLUSION Periprosthetic tibia fractures are difficult to treat and have a high risk of nonunion and reoperation even with modern plating techniques. Most patients can be treated to union with operative fixation and do not require revision arthroplasty, if the components are stable initially. We recommend dual plating for fractures in the proximal third, and either single plating or nailing for fractures in the middle and distal thirds depending on bone quality, implant positioning, and fracture morphology.
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Affiliation(s)
| | | | | | - Hassan R Mir
- Florida Orthopaedic Institute, Tampa, FL, United States; University of South Florida, United States
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